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Time to Talk: Campaigns fight stigma that follows mental illness

Efforts seek to define mental health in a positive way

Dan Jackson calls his mental health a lifelong journey. He has been diagnosed with dysthymia, described as a chronic and mild form of depression and, more recently, with other issues linked to his childhood. He manages his mental health challenges by seeing a therapist once a week for an hour and expressing his feelings to the people closest to him.

Dan Jackson was at dinner with a colleague when he felt the onset of a panic attack. So he took a Xanax, prescribed by his psychiatrist tocalm him. When his colleague’s tone of voice and facial expression changed as he questioned him about the medication, Jackson felt like he was being judged.

“The stigma is, `There is something wrong with that person, they are on medication,’ ” Jackson, 43, said.

A former English as a Second Language teacher, Jackson has a master’s degree in English. He likes to travel. He taught English in South Korea. He also is among the one in five adults in America with a mental illness. As a child, he was diagnosed with dysthymia, described as a chronic and mild form of depression, and more recently with other issues linked to his childhood.

To focus on his mental health, Jackson stopped teaching and moved in with his mother in Aurora. He sees a psychiatrist once a week for an hour. He helps out at his father’s business and does part-time jobs every so often. He doesn’t know if he will teach again, but he has plans to move into his own place within the month.

“There are things you can do, there is help out there,” Jackson said. “I was at a hopeless point, but now I don’t feel hopeless.”

Jackson also is at a point where he feels comfortable talking about his mental illness and reaching out for help. But mental health experts say many others in similar situations are not receiving the treatment they need because they are embarrassed, ashamed or feel guilty about letting others know they are struggling mentally.

Stigma ‘is deep’

“If you were to break your arm, you would retell the story in detail,” said Patti Boyd, manager of strategic partnerships of Tri-County Health Department, a public health agency that provides services to Douglas, Arapahoe and Adams counties. “When there is a mental health issue, people just don’t want to talk about it.”

To combat the stigma of mental illness, Tri-County launched a campaign in May called “Let’s Talk Colorado.”

Rather than just addressing mental illness, the campaign promotes mental health as a state of well-being and balance in people’s thoughts and behaviors, Boyd said. The goal is to make mental health a collective focus for all of Colorado so that people with mental health issues will seek treatment.

“People know there is care but they don’t seek it because they don’t want people to know that they are having a mental health issue,” Boyd said. “The level of stigmatizing language that we aren’t aware of is so deep.”

The statewide campaign is part of a growing trend of efforts to fight stigma. Mental Health Colorado is building a statewide network of advocates to improve mental health care called Brain Wave. The national campaign MakeItOk.org clarifies on its website what a mental illness is and is not, provides a questionnaire asking users if they participate in stigmatic behaviors and tells the stories of people who have felt the effects of stigma.

“My family and friends thought my depression and possible bipolar episodes were all in my head,” a woman named Andrea shares on the MakeItOk website. “They didn’t understand why I had trouble getting out of bed or why I cried so much. I was just `oversensitive.’ ”

Andrew Romanoff, president and CEO of Mental Health Colorado, is using the organization’s website to reduce stigma. Mentalhealthcolorado.org has dozens of stories from people who have experienced mental illness in themselves or in a person close to them. Sharing stories is a “powerful way to demystify mental illness,” Romanoff said.

“What we are tackling here is not some exotic disease that is confined to a tiny fraction of the population,” he said. “Mental illness touches every single family in Colorado and our story bank reflects that.”

Research shows that stigma campaigns are effective.

Using a grant from the Colorado Health Foundation, Tri-County Health requested a study from Frameworks Institute, an independent nonprofit research organization based in Washington, D.C., on how the public communicates about mental health.

“We are excited to have been able to do this work and start this conversation in Colorado in a meaningful way,” Boyd said. “We can do this better, we have evidence.”

In the study, a team of Ph.D. researchers interviewed at length 10 mental health experts and 10 residents of Douglas, Arapahoe and Adams counties on their perceptions of mental health. Participants acknowledged that people with mental illness should not be stigmatized, which is a “testament to the success of stigma campaigns,” said Moira O’Neil, director of research interpretation and application at Frameworks Institute.

But “while they can explicitly say `no, people with mental health should not be stigmatized,’ when they talk about mental health issues, there is an `otherizing’ process that ends in stigmatization,” O’Neil said. That means the language used in conversation indicates “I am normal” and “that person is not.”

The study — which Tri-County will use as a tool and model for communicating about mental health — found that people struggle to talk about mental health as a positive state that everyone has and requires support for, O’Neil said.

‘A positive definition’ of mental health

The U.S. Department of Health and Human Services defines mental health as emotional, psychological and social well-being. It affects how individuals think, feel and act. It helps determine how individuals handle stress, relate to others and make choices. And “it is important at every stage of life,” the department of health and human services says.

The problem is that experts and individuals do not use that positive definition enough, O’Neil said.

“The public does not have access to a positive definition of mental health,” she said. “It is something that they struggle to talk about beyond mental health being the absence of disease.”

In therapy over the past three years, Jackson has developed self-acceptance and resilience. His therapist has helped him work through issues he has struggled with since childhood. His mother’s support and care has helped him open up about how he is feeling. He said he now recognizes that the pain his mental illness causes does not mean there is something wrong with him.

But he still finds it difficult to explain his mental health challenges to his “ bestest of friends with the biggest hearts.”

More awareness, education and empathy around mental illness is needed, he said.

“We should listen to everyone because you don’t know what people are going through — that’s the bottom line,” Jackson said. “It could be anyone.”

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